Bill Gates: What I Learned in the Fight Against Polio

Bill Gates meets with a farmer in the Indian village of Guleria in May 2010 to talk about the country's polio program. India has now been polio-free for more than two years.
Bill & Melinda Gates Foundation

Our foundation began working in India a decade ago, at a time when many feared that the country would become a flashpoint for HIV/AIDS. Since then, we have expanded into other areas, including vaccines, family planning and agricultural development. In all of this work, Melinda and I have seen many examples of India's poor making dramatic contributions. But nowhere has this power been demonstrated more clearly than in the fight to end polio. Indeed, India's accomplishment in eradicating polio is the most impressive global health success I've ever seen.

I first began traveling to India in the 1980s, drawn by a fascination with this ancient country that cherishes its history and harbors great ambitions for the future. My interest was professional as well as personal. Microsoft was expanding, our need for talent was growing, and I was attracted to the vitality and ingenuity of the Indian people.

A few years later, several colleagues and I were flying into Bangalore. As we made our final approach, I looked out the window and saw an area of densely packed, tiny, dilapidated homes stretching out for miles. At that moment, one of my Indian companions declared proudly, "We have no slums in Bangalore." Whether out of denial or innocence, my colleague didn't see the "other" India. I don't mean to single him out. It can be easy to turn our eyes away from the poor. But if we do, we miss seeing a society's full potential.

When Melinda and I started our foundation's work in India, we began to meet people from the areas we'd been flying over. They had little education and poor health, and lived in slums or poor rural areas—the kind of people many experts had told us were holding India back. But our experience suggests the opposite: What some call a weakness can be a source of great strength.

In 1988, when there were approximately 350,000 new polio cases a year and the disease was crippling children in 125 countries, the World Health Assembly set the goal of eliminating polio world-wide. Progress came quickly. By 1994, the Americas were polio-free. Soon we saw the last case in China, the last case in the Pacific, the last case in Europe. By the year 2000, the number of polio cases had dropped by 99%. But the task of ending polio was not 99% done.

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The remaining cases were concentrated in fewer countries, and India was one of the last nations left. This was no surprise. India's urban centers are among the world's most densely populated. Its rural communities are dispersed across a vast and often inaccessible terrain. The country suffers from poor sanitation. Its 1.2 billion citizens are highly mobile and give birth to 27 million new Indians every year. Experts predicted that polio would be eliminated in every other country before it was eliminated in India.

But India surprised them all: The country has now been polio-free for more than two years. India's success offers a script for winning some of the world's most difficult battles in every area of human welfare. The key has been the participation of the humblest, most vulnerable members of the Indian population.

To be successful, any campaign this big has to include a clear goal, a comprehensive plan and precise measurements of progress. But the antipolio campaign in India took a crucial extra step: It enlisted the support of the full sweep of Indian society, including health workers, ordinary citizens and some of the poorest people in the most impoverished regions of the country.

The heart of the plan was a simple and inspiring mission: to find the children. To defeat polio, it is essential to achieve up to 95% vaccination coverage in afflicted areas. There is no way to measure whether you're meeting that mark unless you know how many children there are, where they are and whether they've been vaccinated.

India responded to this challenge with an army of more than 2 million vaccinators, who canvassed every village, hamlet and slum. Vaccinators took the best maps they had and made them better. They walked miles every day and worked late into the night. They found children in the poorest areas of Uttar Pradesh and in the remote Kosi River area of Bihar—an area with no electricity that is often flooded and unreachable by roads. They found the sons and daughters of migrant workers in bus stations and train stations, accompanying their families on their way to find work.

When Melinda and I visited India in March 2011, two months after the last case of polio was identified, we traveled to a brick kiln whose workers labored long hours at low wages and lived in mud huts. We met a young mother and asked if her children had been vaccinated. She ducked into her hut, retrieved a bag that held all her possessions, and rummaged around the bottom of it until she proudly produced an immunization card listing the names of all her children and showing that each had received the polio vaccine—not just once, but several times. We were amazed.

Wherever India's vaccinators have gone, they've had help from local residents. In one Kolkata slum, a group of schoolchildren who call themselves the Daredevils have been relentless in this effort. Their community had never had house numbers, so the children assigned numbers. Using donated cellphones connected to global positioning satellites, they created a digital map, marking each house where children hadn't been vaccinated.

The fight to end polio is not over, not even in India, and new polio cases in the Horn of Africa and Syria underscore the importance of eradicating polio everywhere. Still, if the world maintains its funding and commitment, we can eradicate the disease globally within six years.

The accomplishments of India's vaccinators and children and politicians will not end when polio ends in their country. Now that they have found India's children, they can bring them and their families other vaccines, clean water, education, advice on maternal and child health, and support for agriculture—all the things that people need to live healthy and productive lives.

Years ago, on that day we were landing in Bangalore, I didn't know nearly as much about India as I do now. I saw India's obvious talent and energy, but, like my colleague, I missed its hidden strength—the rich, the powerful and the poor working together toward a common goal.

—Mr. Gates is the co-founder and chairman of Microsoft and co-chair of the Bill and Melinda Gates Foundation. This essay is adapted from his contribution to "Reimagining India: Unlocking the Potential of Asia's Next Superpower," edited by McKinsey & Company.

People, like me, who are not professionals but are interested in this area, may benefit from Yale's Prof. Frank Snowden's lecture on Polio and, indeed, his whole survey of the experience of humans and infectious disease at Yale's open courses.

Supporting the so called common core isn't serving mankind but attacking our liberty ns freedom to teach our children not get a soviet style curriculum. He should be using his money to end central banks the wrist scourge on mankind

I think next big milestone for India should be the eradication of hunger and malnutrition. India has more hungry children than anywhere in the world. It is not because of money or overpopulation that many Indians love point. With motivation like Bill Gates inspired, there is no reason for any child go to bed hungry.

I really admire Bill and Melinda Gates for their philanthropy and the immense good they do around the world. With that being said, I would appreciate them keeping their money out of Colorado politics, especially when the issue in question is a progressive income tax and end-run around TABOR. They are not Colorado residents or taxpayers, and should really not interfere in our state.

Great article. Polio eradication from India is the result of effort by many many people and organizations.Congratulations to Bill and Melinda Gates foundation for doing what they do in the most vulnerable sections of mankind. Also as some here have pointed out, billionaires in India should learn from this foundation. What is the point of amassing tens of billions and live in multi-billion dollar houses if one is not of use to society?

QUOTE - BILL GATES: mission: to find the children. To defeat polio, it is essential to achieve up to 95% vaccination coverage in afflicted areas. There is no way to measure whether you're meeting that mark unless you know how many children there are, where they are and whether they've been vaccinated.

India responded to this challenge with an army of more than 2 million vaccinators, who canvassed every village, hamlet and slum. Vaccinators took the best maps they had and made them better.

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QUOTE - ERNST VON SALOMON [The Questionnaire, 1945] The bureaucracies have always known the magic of a power that ‘arrests’ the individual most securely in registering him. Registration is the most sublime form of terror, that out of which all the other consequences of the regime of terror follow ... No form has ever left an office that attached any importance to it, without taking on the character of a wanted poster.

**

Can these two views of 'census' be reconciled?

Perhaps.

But anyone who supposes there is no need to reconcile them, is afflicted by misconceptions more dangerous than polio.

I am bewildered that Mr. Gates did not recognize the efforts of Rotary International to eradicate Polio in this article. We all know that he knows what Rotarians have done. Why leave Rotary out? Very strange

Amazing work by Bill and his foundation. I know a lot of folks are skeptical which is healthy but we must also acknowledge the amazing progress and potential. I lived five years in Bangalore myself and drove a number of initiatives in Healthcare in Karnataka and MP via Tele-medicine and it was the most satisfying time of my career.

Bill Gates his wife, Buffet, Winfrey, Rockefellers, Bloomberg, Soros, Turner have one sordid agenda to reduce the world’s population in half so there are more resources for them and the Democrat Party survivors. He is the leader of the Malthusian movement using his money to kill.

As reported by Forbes magazine he discovered that couples had fewer children if the survival rate of the first children was greater. The world knows no greater evil than Gates and his crew supported by the tyrant in the WH.

The Gates are the leaders of the population control movement. THey ought to be digging well and providing sanitary conditions and eliminating the Rachel Carson movement killing people with Malaria needlessly.

Look no further than the Democrat party if you want hate of people by abortion and their culture of death.

"To be successful, any campaign this big has to include a clear goal, a comprehensive plan and precise measurements of progress."

yes, and a very admirable goal in this case. you might also want to add a stable, non-violent society where people have a modicum of trust in each other, which somalia and syria do not currently have.

"But the antipolio campaign in India took a crucial extra step: It enlisted the support of the full sweep of Indian society..."

this can be more difficult than it sounds. 1.2 billion people can mean 1.2 billion conflicting interests. how to convince nearly everyone to cooperate, especially when fears and beliefs about demons, magic powers and conspiracies abound? i doubt if a vaccine by injection would be so successful, due to various fears.

Please continue to help the third world and leave us alone. Your recent attempt to impose billions in new taxes on Colorado for supposed education, just a huge tax increase to fund the teachers union pension fund was despicable. You really want to help peope, fight to get the DDT ban overturned, saving millions of Africans from malaria.

Bill Gates has been the example to the world of how a wealthy man acts responsibly. It is interesting to compare an contrast him to other Tech leaders (current and former). He pretty much wins the race by miles, showing that it isn't all about how much stuff you have...

The real reason why Polio persists in this world is because of islam. The last vestiges of the disease are squarely in countries with muslim majorities.

Many backwards villages are suspicious of western "paganism" and believe that our vaccinators are here to sterilize their women rather than offer them a cure to a debilitating and paralyzing disease.

In fact, some vaccinators were killed in Nigeria when a man rode up on a trike and shot them dead with those exact, misguided beliefs.

It is also amusing that western society, with her Christian foundations, mimics the Moses of old holding up the bronze serpent with any Israelite looking up being instantly cured. The USA offers a simple cure and islam spits in our faces.

I would advocate that we simply allow islamic countries to wallow in their own filth were not for the fact that polio is an equal opportunity disease and spreads easily. Good on Gates to keep up the good fight - I've lost patience for it long ago.

What amazes me is that Al Sabin gets no credit for having developed the first and only permanent polio vaccine.

I knew him, he was brilliant and coudn't suffer a fool for an instant. He deserves enormous credit anf get close to none.

The vaccine was a couple of drop of vaccine on a sugar cube. Chew or swallow the cube and you are immunized for life.

He did this wonderful thing with two technicians, in a small lab at Cincinnati Children's Hospital and a room full of primates. .

I had gotten him to address a group of pre med advisors and their wives during their tour of the University of Cincinnati School of Medicine. The advisors and their wives stood in respect, applauded and some of the women had tears in their eyes.

It is a magnificent piece of work that he did but very little recognition was ever afforded to him. I have never understood why that is.

Here is a far different perspective on Gates' India polio vaccine program by Dr. Jacob Puliyel, head of the Department of Paediatrics, St Stephens Hospital, Delhi. This medical journal article was published in the peer-reviewed Indian Journal of Medical Ethics Vol IX No. 2, April - May 2012http://www.issuesinmedicalethics.org/202co114.html

First a brief definition: Acute Flaccid Paralysis (AFP) is paralysis, just like polio paralysis. It can be caused by vaccine adverse reactions. AFP in India has increased astronomically since Gates and the WHO commenced non-stop, repeat polio vaccinations using OPV, a dangerous vaccine that has been banned in the US. ***************************************Polio programme: let us declare victory and move on.Indian Journal of Medical Ethics

'The elephant in the room: the problem of non-polio Acute Flaccid Paralysis (AFP)

It has been reported in the Lancet that the incidence of AFP, especially non-polio AFP has increased exponentially in India after a high potency polio vaccine was introduced (25). Grassly and colleagues suggested, at that time, that the increase in AFP was the result of a deliberate effort to intensify surveillance and reporting in India (26). The National Polio Surveillance Programme maintained that the increased numbers were due to reporting of mild weakness, presumably weakness of little consequence (27). However in 2005, a fifth of the cases of non-polio AFP in the Indian state of Uttar Pradesh (UP) were followed up after 60 days. 35.2% were found to have residual paralysis and 8.5% had died (making the total of residual paralysis or death - 43.7%) (28). Sathyamala examined data from the following year and showed that children who were identified with non-polio AFP were at more than twice the risk of dying than those with wild polio infection (27).

Data from India on polio control over 10 years, available from the National Polio Surveillance Project, has now been compiled and made available online for it to be scrutinised by epidemiologists and statisticians (29).

This shows that the non-polio AFP rate increases in proportion to the number of polio vaccine doses received in each area. Nationally, the non-polio AFP rate is now 12 times higher than expected. In the states of Uttar Pradesh (UP) and Bihar, which have pulse polio rounds nearly every month, the non-polio AFP rate is 25- and 35-fold higher than the international norms.'

Thanks, Bill. I've been in Rotary since 1968 and know this was a real project for us for a long time. Google writes that we first vaccinated children in 1979--ironically in the Philippines. It is odd knowing that he attended the convention in New Orleans, I believe, and this was the mainstay of his speech. Oh, well. The important thing is the results.

Totally called for. His support of bernanke and big govt is a threat to liberty. His products were terrible, he had no sense of design or liberating people like Steve jobs. He forced his model on everyone and his views on social engineering is scary, he is anti liberty just like Buffett. People like Jobs, ford, Carnegie, James Hill, Edison changed the world for the better. Gates taking his money to support left wing elites is threat to freedom..

Gates Foundation is currently funding very promising research in an alternative to oral polio vaccine (OPV) and injectable polio vaccine (IPV). This will be an orally administered capsule with a cost advantage of at least 100 (current technology) to 1 (new technology). Laboratory results have been terrific and steps to bring it to market are likely to begin very soon.

This new technology (Chloroplast Transformation Technology or CTT) produces polio vaccine, or for that matter other vaccines and other pharma products, in plants such as lettuce. Dr. Henry Daniell at University of Pennsylvania is the lead researcher with dozens of patents. CTT involves expression of certain proteins in transgenic chloroplasts, which in turn are potentially useful in prevention, diagnosis, mitigation, and treatment of human diseases and health conditions. Genetic engineering of plant (for example lettuce) chloroplasts is ideally suited for low cost production of biopharmaceuticals (such as insulin, interferons, albumins, clotting factors) and vaccine antigens (malaria, amebiasis, cholera, plague, anthrax, dengue, etc.) CTT is a very robust platform with applications in various non-medicine fields such as bio fuels, veterinary sciences, textiles, etc.

In 2003 there were 8,000 cases of AFP; in 2011 there were 60,000 cases. The largest number of oral polio doses in India was given in 2004, which also had the lowest number of AFP cases in the past decade. There is considerable debate about the actual reason for increased AFP; one theory is that the vastly improved surveillance of India's children is making it possible to know accurately the incidence of disease that could only be estimated in the past.

There were pockets of resistance to the vaccination programs, especially among the minority population in India. The vaccination effort was seen as an effort by the majority to sterilize the future generation. This was one of the major contributor for the 5% of the population that were not inoculated. I hope these people realize the benefits of the vaccine and decide to immunize their children.

Steve Jobs estate is $7.9Billion tax free, I have not seen one initiative come from his when he was alive or now. Funny he visited India in his younger hippie days! Gates has done more for humanity then 100 Steve Jobs!

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